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Symptoms predictive of myocardial infarctions differ by race, gender

The predictive value of some symptoms indicating a patients' risk for myocardial infarctions and other acute coronary syndromes varies by gender and race, according to research published in the Emergency Medicine Journal.

“Classic symptoms of heart attack include pain in the center of the chest, shortness of breath, sweatiness, and pain that goes down the left arm. Prior research showed that females, older adults and people with conditions such as diabetes, do not show these classic symptoms,” Jesse Pines, MD, and director of the Center for Healthcare Innovation and Policy Research at the George Washington University School of Medicine and Health Sciences, said in a press release. “We wanted to know how different combinations of race and gender play into this. Our overall goal was to better pinpoint what predicts these non-classic presentations of [acute coronary syndromes].”

Pines and colleagues conducted a secondary analysis of data from a prospective, observational cohort study of a convenience sample of 4,162 ED patients who presented with chest pain from 1999 to 2008. The relationship between chest pain symptoms and 30-day outcomes for acute coronary syndromes was the primary outcome, and serious cardiopulmonary diagnoses was the secondary outcome among black and white men, and black and white women. Two dozen characteristics of chest pain and associated symptoms, as well as cardiac history and risk factors were also assessed.

Researchers found that in black men, diaphoresis was associated with acute coronary syndromes (OR = 1.47; 95% CI, 1.02-2.13), but in white men, left arm radiation (OR = 1.73; 95% CI, 1.16-2.59), pressure/tightness (OR = 1.65; 95% CI, 1.16-2.59) and substernal pain OR = 1.51; 95% CI, 1.07-2.11) were associated with acute coronary syndromes.

In addition, in black women, diaphoresis (OR = 1.66; 95% CI, 1.17-2.35), palpitations (OR = 1.66; 95% CI, 1.13-2.45) and left arm radiation (OR = 1.44; 95% CI, 1.02- 2.03) were associated with acute coronary syndromes while pleuritic pain (OR = 0.69; 95% CI, 0.5- 0.96) and left anterior chest pain (OR = 0.54; 95% CI, 0.35- 0.84) lowered the acute coronary risk.

Researchers also found that in white men, serious cardiopulmonary diagnoses were more likely with left arm radiation (OR = 1.58; 95% CI, 1.07-2.34) and less likely with right anterior chest pain (OR = 0.43; 95% CI, 0.2-0.92). Among black women, serious cardiopulmonary diagnoses were more likely with palpitations (OR = 1.65; 95% CI, 1.14- 2.38) and diaphoresis (OR = 1.61; 95% CI, 1.15-2.24) and less likely with pleuritic chest pain (OR = 0.59; 95% CI, 0.39-0.88) and with left anterior chest pain (OR = 0.65; 95% CI, 0.48-0.89).

In addition, no symptoms were determined to be predictive of serious cardiopulmonary diagnoses in black men and white women, and no symptoms predicted acute coronary syndrome in white women.

“While our findings do require additional study to be replicated in other ED settings, they should raise awareness among ED physicians, primary care physicians and cardiologists that race and gender are important factors when assessing chest pain and that suggestive symptoms may be variably predictive in different patients,” Ahmed Allabban, MD, department of emergency medicine, George Washington University and colleagues wrote. “We also demonstrate that the broad category of ‘atypical’ pain may be less useful than individual symptoms in different combinations of race and gender.”

Researchers suggested that future studies are needed to evaluate potential mechanisms to explain how gender and race modify acute coronary syndromes and serious cardiopulmonary diagnoses presentations. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.